Are you familiar with the World War I slogan Uncle Sam wants YOU? Well, Uncle Sam still may want you, but your local blood center may not. Because it is now well known that certain diseases can be transmitted via homologous blood transfusions (in which blood is received from a donor other than oneself), screening procedures have become increasingly stringent. Even so, we continue to worry about the safety of our blood supply and how our blood centers are monitored. Such concern is reasonable considering that any of us may need a blood transfusion at some point in our lives.

Blood centers are unusual in that they are largely private enterprises that are governed and supervised by public agencies. No longer is the Red Cross the only agency that handles blood nationally. In many communities, the local Red Cross group handles no blood, instead focusing its energies on disaster relief and CPR and first aid training. (As the Red Cross is currently structured, the local community can elect to manage the blood business, and many communities have decided to let agencies other than the Red Cross handle their blood.)

Whatever system has been established by the local community, the agency that accepts human blood donations is closely monitored by the Food and Drug Administration, and is subject to its regulations. Whenever violations persist past the time allowed for correction, the FDA can suspend or cancel the center's license and literally shut it down. In addition to governmental supervision, most blood centers are members of one or more professional organizations. These organizations, which include the American Association of Blood Banks and the Council of Community Blood Centers, all set professional accrediting standards for safety procedures in the screening and handling of blood. Hence, there is no such thing as a locally autonomous blood center.

Why would a center reject the offer of blood? Simply because the only acceptable blood donors are healthy individuals--people who have no history of diseases that could be transmitted through the blood. Perhaps the two most feared diseases that can be passed on in this manner are AIDS and hepatitis virus, both of which are incurable. Prescreening questionnaires are designed to eliminate individuals who are likely to be at risk for these diseases. Other health factors are also considered in potential donors; for example, individuals weighing less than 100 pounds are not permitted to donate blood.

Volunteer donors are not at risk for contamination. The needles and containers that hold the blood are discarded after being used once. The person drawing the single pint of blood that is being donated is either a trained medical technician or nurse. These health professionals have been educated as to how to avoid practices that might lead to contamination.

After blood has been collected, it is tested extensively to provide the potential recipient the maximum protection against acquiring disease. Of particular concern are the various tests for different forms of hepatitis, and HIV (the virus that causes AIDs). Regarding hepatitis, at least three tests are performed to check for antibodies or antigens that would indicate the presence of hepatitis B or C. As for HIV, all blood centers routinely check the blood for the HIV-1 antibody, which, if present, would indicate that the blood was contaminated. As a further safeguard, testing for the HIV-2 antibody is expected to be mandated shortly. The FDA also is currently recommending the use of yet another blood test (now in the last stage of clinical trials) for HIV antibodies. This test can detect the virus 6 days earlier than other tests. It is hoped that it will prevent transmission of a few more cases of AIDS annually. In addition to tests for hepatitis and HIV, blood is routinely checked for syphilis and leukemia.

Statistics indicate that homologous blood transfusion is safer than it has ever been. The improved testing procedures in current use have minimized the likelihood of getting hepatitis from a transfusion to less than 3%. As recently as the 1960s, up to 25% of patients who received banked blood also contracted hepatitis. Once the medical community became aware that HIV could be transmitted through blood transfusions, industry-wide safeguards were designed and applied, so that now the risk of getting AIDs from transfusion is less than 1%.

Despite public awareness that the risk of transfusion-acquired hepatitis or HIV infection is extremely low, any risk at all is considered significant by most people. In fact, increasing numbers of patients with upcoming elective surgery are opting for an autologous preoperative transfusion; that is, they are storing their own blood prior to surgery. Given that a zero-risk blood supply is generally considered impossible by medical researchers, and because hepatitis and AIDS pose such formidable threats, it is expected that alternatives to homologous blood transfusions will continue to be sought.